MEMORANDUM OF UNDERSTANDING

This Memorandum of Understanding (the “MOU”) is entered into this ___ day of ____
2020, at Butuan City, by and between:

_______________________________, a local government unit under the

Republic of the Philippines, with principal office address at
_____________________________, represented herein by its
___________________, __________________, hereinafter referred to as the
“________________________”;

- and -

SANTOS CLINIC, INC. or MANUEL J. SANTOS HOSPITAL (MJSH), a

corporation duly organized and existing under and by virtue of the laws of the
Philippines, with office address at 554 Montilla Boulevard, Butuan City,
Philippines, represented on this act by its Chief Operating Officer, DR.
TERENCE ANTHONY S. VESAGAS, hereinafter referred to as “SEHI”.

(_____________________ and MJSH shall hereinafter collectively and

individually be referred to as “Parties” or “Party”)

WITNESSETH: THAT

WHEREAS, MJSH is a Secondary Level Hospital in Butuan City which applied for and was
granted an accreditation with the Research Institute for Tropical Medicine (RITM) and the
Department of Health (DOH) to become a duly licensed CoVid-19 testing facility.

WHEREAS, pursuant to the mandate provided in its charter to serve and promote the general
welfare of its constituents, ___________________ undertakes to provide assistance to its
constituents and other individuals within its jurisdiction who shall be required to undergo RT-
PCR tests or admission in a medical facility.

WHEREAS, __________________expressed its intention to avail of MJSH’s Rapid PCR facility

services as well as its hospital services for the benefit of its affected constituents and other
covered individuals, including locally stranded individuals (LSIs), frontliners, and health
workers.

WHEREAS, MJSH signified its conformity to the offer made by the ______________________.

NOW, THEREFORE, for and in consideration of the premises, mutual representations,

warranties, covenants, agreements and conditions herein contained, the Parties hereto agree as
follows:

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SECTION 1.

Effectivity. This Agreement shall be effective from the date of signing hereof and shall stay
in force until validly terminated by mutual agreement of both parties.

SECTION 2.

Obligation of the Parties. The Parties shall be responsible for the following:

a. MJSH shall accommodate all RT-PCR referrals made by the ________________ and
provide the appropriate services requested.

b. For RT-PCR Referrals, the following procedures shall apply:

(i) LGU shall conduct the swabbing and shall be responsible for securing samples
and filling-up of the Case Investigation Form (CIF) and submit both to MJSH;

(ii) MJSH shall in turn conduct the RT-PCR testing and once results are available,
shall follow the DOH Guidelines in the releasing and reporting of such result;

(iii) Since swabbing in this case is done by non-MJSH employees, MJSH reserves the
right to reject samples found to have not followed the guidelines on specimen
handling and transport.

c. MJSH shall bill ___________________ for all RT-PCR referrals at a rate equal to PHIC
case rate for conventional RT-PCR testing. This charge shall then be reimbursed to the
___________________ once MJSH’s claims for the referred tests are paid by PHIC. In
the event that PHIC coverage is not secured or applicable, _______________ undertakes
to shoulder in full the payment due for such non-PHIC covered cases.

d. MJSH undertakes to provide __________________ with a billing statement for the RT-
PCR referrals. The _________________ shall have seven (7) days to question such
billing. Absent any objection on the billing within the period provided, the
___________________ binds itself to settle such account within thirty (30) days from
receipt of the billing statement

e. MJSH undertakes to reimburse the ____________________ for the RT-PCR referrals

within thirty (30) days from receipt of payment from PHIC.

f. For disputed billings, Parties shall have fifteen (15) days to settle the same.
________________ undertakes to pay within thirty (30) days from the settlement of the
disputed billing.
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 g. MJSH reserves the right to withhold the provision of RT-PCR services in any of the
following events:

i. Default in payment for at least two (2) months on the part of the
_______________; and

ii. Failure to settle the disputed billing within the period provided above.

SECTION 3.

Confidentiality. All Confidential Information shall be kept in strict confidence by both

Parties and each Party shall use the same degree of care to prevent and avoid unauthorized
disclosure and reproduction thereof by their respective Representatives as it uses to prevent
and avoid such disclosure and reproduction of its own Confidential Information of similar
nature, provided always that the standard of care exercised shall not be less than a reasonable
standard.

SECTION 4.

Governing Law. This Agreement shall be governed by and construed in accordance with the
laws of the Republic of the Philippines.

SECTION 5.

Entire Agreement. This Agreement constitutes the entire understanding between the Parties
hereto and supersedes all prior agreements regarding the subject matter hereof. No waiver,
modification, termination, or addition to this Agreement shall be valid unless in writing and
signed by all the parties to this Agreement at the time of such waiver, modification,
termination or addition.

SECTION 6.

Assignment. This Agreement shall inure to the benefit of and be binding upon the Parties
and their respective successors and permitted assigns. Nothing in this Agreement, expressed
or implied, is intended to confer on any person other than the Parties and their successors and
permitted assigns, any rights, benefits, privileges, liabilities or obligations under or by reason
of this Agreement.

IN WITNESS WHEREOF, the parties hereto have set their hands this ____day of
___________ 2020 at Butuan City.

__________________________ _____________________________
Dr. Terence Anthony S. Vesagas _____________________________
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 Chief Operating Officer _____________________________
Manuel J. Santos Hospital _____________________________
WITNESSES:

___________________________ ___________________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

________) S.S

At the above-mentioned place, this ___ day of __________ 2020, personally appeared
before me:

Name CTC Date/Place Issued TIN

Known to me as the same persons who executed the foregoing instrument and who
acknowledge to me that the same is their free act and deed and that of the offices they
respectively represent.

WITNESS MY HAND AND SEAL on the date and place mentioned above.

Doc. No. __________

Page No.__________
Book No. __________
Series of 2020.